Pulmonary embolism: treatment. Part 2

Abstract

Pulmonary embolism is a potentially fatal disorder with a lethality rateof 30% when not treated. A quick diagnosis is fundamental. Treatmentreduces mortality and morbidity, and improves quality of life by reducingthe probability of thromboembolic pulmonary hypertension and postthromboticsyndrome events. Standard treatment for patients withpulmonary embolism is full anticoagulation with non-fractionated orlow molecular weight heparin, associated with oral anticoagulation withwarfarin. Exceptions include patients with absolute contraindicationsfor anticoagulation, who may be submitted to insertion of an inferiorvena cava filter or to surgical or catheter embolectomy. Patients withhemodynamic instability are the primary candidates for thrombolytictherapy. New drugs have been developed and studied, such as directthrombin inhibitors (lepirudin, desirudin, bivalirudin, melagratan,ximelagratan, argatroban, and dabigratan) and selective factor Xainhibitors mediated by antithrombin III, represented by fondaparinux.The objective of this article is to present a review of literature on thepractical aspects of treating pulmonary embolism, including clinical,percutaneous and surgical interventions.

Keywords

• Pulmonary embolism/drug therapy
• Venous thrombosis/drug therapy
• Heparin/therapeutic use
• Heparin low-molecular-weight/therapeutic use
• Thrombolytic therapy
• Vena cava filters
• Embolectomy
• Thromboembolism
• Warfarin/therapeutic use